Patient reported symptom outcomes during medication titration for adult heart failure management.

ABSTRACT

AIMS AND OBJECTIVES: This project used the Patient Reported Outcomes Measurement Information System (PROMIS) tools to evaluate heart failure patient's experiences of dyspnea, fatigue, and physical mobility during initiation and up titration of drugs in an outpatient setting. BACKGROUND: Investigating patient reported outcome may improve adherence to GDMT. Theoretical support for this study is found in the University of California, Theory of Symptom Management. DESIGN: Exploratory, repeated measures design. METHODS: Patients (n = 21) completed three PROMIS questionnaires for dyspnea, fatigue and physical mobility when GDMT was started or up titrated, and again at a follow up appointment within 30 days (+/- 14 days) of the baseline measures. Patients were asked open- ended queries regarding the usefulness of these questionnaires in identifying and managing symptoms. Provider input was sought on usefulness of the tools in clinical practice and decision making. RESULTS: Dyspnea change scores significantly decreased (p = .001), physical mobility scores significantly increased (p = .017), and fatigue scores did not change (p = .319). Duration of HF diagnosis was associated with dyspnea change scores. Patients reported PROMIS tools were easy to use, while providers felt the tools were easy for patients to use but were too long and time intensive for usual office practice. CONCLUSIONS: Dyspnea and physical mobility improved with up titration of GDMT but fatigue did not change. RELEVANCE TO CLINICAL PRACTICE PROMIS tools could be helpful in tracking selected symptom changes during GDMT HF medication initiation or up titration for HF management if reformulated into shorter format.